A bill aimed at streamlining health insurance coverage requests was voted out of its first committee last week. It’s sponsored by Soldotna Republican Rep. Justin Ruffridge, who’s a pharmacist when the Legislature isn’t in session.
Earlier this month, Ruffridge presented the bill to members of the House Health and Social Services Committee, which he also sits on. But first, he explained the subject of the bill – prior authorization – actually means.
“You seek some type of medical care, you have insurance, the insurance says, ‘Well, you must get approval on that before you go forward with service, or we may not pay for it,’” he said. “And that can sometimes delay care.”
Timeliness is a key focus of the bill. If passed, it would give insurance providers three days to decide whether a service is covered. Providers would have one day for expedited requests. The service would automatically be approved if the insurance provider fails to meet those deadlines.
Bud Sexton, Ruffridge’s chief of staff, told lawmakers the new process would be weighted in the patient’s favor – like if there are discrepancies in which services a provider says it covers.
“You know, like in baseball where tie goes to the runner?” he asked. “Well, if there is something different, then patients are the one who benefits – whichever portion is more favorable to the patient.”
The bill’s already picked up endorsements from Central Peninsula Hospital, the Alaska State Medical Association and the Alaska Native Health Board, among other groups.
Gary Strannigan is the vice president of congressional and legislative affairs for Premera Blue Cross Blue Shield of Alaska. He told lawmakers the bill is a compromise that could help make healthcare more affordable by ensuring patients get the right care at the right time. And he says speeding up turnaround times wouldn’t hurt either.
“We think this bill will help incentivize the adoption of electronic products by providers – and for those providers that cling to those fax machines, we trust that eventually the improvements in the process and the system performance will be impossible to resist,” he said.
Right now, the bill’s sitting in the House Labor and Commerce Committee. It’s scheduled to be heard there next week.
